Laboratory Studies

Laboratory studies can include the following:

Complete blood cell (CBC) count
Prothrombin time (PT)/activated partial thromboplastin time (aPTT)/international normalized ratio (INR) - Mild envenomation INR greater than 2; complete defibrination INR greater than 12^[9]
Fibrinogen - Severe envenomation associated with afibrinogenemia (<0.3 g/L)
Fibrin degradation products
D-dimer
Electrolytes
Blood urea nitrogen (BUN) and creatinine
Urinalysis
Arterial blood gas (ABG)
Type and crossmatch for packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets
CSL commercial snake venom qualitative detection kit
Enzyme immunoassays (EIAs) for quantifying venom concentration^[10]: A small study of 27 brown snake envenomed patients showed the median venom concentration was 20 ng/mL. The EIA test is able to detect down to concentrations of 3 ng/mL.^[11]

Imaging Studies

Imaging studies may include chest radiography and computed tomography (CT) scan of the head if intracranial hemorrhage is suspected.

Other Tests

Electrocardiogram (ECG) may be necessary.

Treatment & Management

Clinical Toxinology Resources. Pseudonaja textilis. Available at http://www.toxinology.com/fusebox.cfm?fuseaction=main.snakes.display&id=SN0533. Accessed: May 12, 2016.
Singh RR, Uraiya D, Kumar A, Tripathi N. Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India. Indian J Crit Care Med. 2016 Jul. 20 (7):404-8. [QxMD MEDLINE Link].
Ou J, Haiart S, Galluccio S, White J, Weinstein SA. An instructive case of presumed brown snake (Pseudonaja spp.) envenoming. Clin Toxicol (Phila). 2015. 53 (8):834-9. [QxMD MEDLINE Link].
Isbister GK, Scorgie FE, O'Leary MA, Seldon M, Brown SG, Lincz LF. Factor deficiencies in venom-induced consumption coagulopathy resulting from Australian elapid envenomation: Australian Snakebite Project (ASP-10). J Thromb Haemost. 2010 Nov. 8(11):2504-13. [QxMD MEDLINE Link].
Allen GE, Brown SG, Buckley NA, O'Leary MA, Page CB, Currie BJ, et al. Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming--Australian snakebite project (ASP-14). PLoS One. 2012. 7(12):e53188. [QxMD MEDLINE Link]. [Full Text].
Keith J, White J, Pascu O, Faian V, Keith J. Fatal cerebellar hemorrhage following Australian brown snake envenomation. Can J Neurol Sci. 2012 Jan. 39(1):120-1. [QxMD MEDLINE Link].
Berling I, Brown SG, Miteff F, Levi C, Isbister GK. Intracranial haemorrhages associated with venom induced consumption coagulopathy in Australian snakebites (ASP-21). Toxicon. 2015 Aug. 102:8-13. [QxMD MEDLINE Link].
de Silva HA, Ryan NM, de Silva HJ. Adverse reactions to snake antivenom, and their prevention and treatment. Br J Clin Pharmacol. 2016 Mar. 81 (3):446-52. [QxMD MEDLINE Link].
CSL Antivenom Handbook. CSL Brown Snake Antivenom. Available at http://www.toxinology.com/generic_static_files/cslavh_antivenom_brown.html. Accessed: May 12, 2016.
Maduwage KP, O'Leary MA, Silva A, Isbister GK. Detection of Snake Venom in Post-Antivenom Samples by Dissociation Treatment Followed by Enzyme Immunoassay. Toxins (Basel). 2016 Apr 28. 8 (5):[QxMD MEDLINE Link].
O'Leary MA, Isbister GK, Schneider JJ, Brown SG, Currie BJ. Enzyme immunoassays in brown snake (Pseudonaja spp.) envenoming: detecting venom, antivenom and venom-antivenom complexes. Toxicon. 2006 Jul. 48(1):4-11. [QxMD MEDLINE Link].
Yeung JM, Little M, Murray LM, Jelinek GA, Daly FF. Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. Med J Aust. 2004 Dec 6-20. 181(11-12):703-5. [QxMD MEDLINE Link].
Brown SG, Caruso N, Borland ML, McCoubrie DL, Celenza A, Isbister GK. Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy. Intensive Care Med. 2009 Sep. 35(9):1532-8. [QxMD MEDLINE Link].
Isbister GK, Brown SG, MacDonald E, White J, Currie BJ. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J Aust. 2008 Apr 21. 188(8):473-6. [QxMD MEDLINE Link].
Ryan NM, Kearney RT, Brown SG, Isbister GK. Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22). Clin Toxicol (Phila). 2016. 54 (1):27-33. [QxMD MEDLINE Link].
Morais V. Antivenom therapy: efficacy of premedication for the prevention of adverse reactions. J Venom Anim Toxins Incl Trop Dis. 2018. 24:7. [QxMD MEDLINE Link].

Media Gallery

Pseudonaja guttata (speckled brown snake).
Pseudonaja textilis (eastern brown snake).
Pseudonaja modesta (ringed brown snake).
Pseudonaja nuchalis (western brown snake).

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Author

David Cheng, MD Associate Professor of Emergency Medicine, Education Director, Associate Emergency Medicine Residency Director, Case Medical Center

David Cheng, MD is a member of the following medical societies: American College of Emergency Physicians, International Society for Mountain Medicine, Council of Residency Directors in Emergency Medicine, American Heart Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

David Eitel, MD, MBA Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Dire, MD, FACEP, FAAP, FAAEM Professor of Pediatrics and Emergency Medicine, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Shaun J Chun, MD, to the development and writing of this article.

Brown Snake Envenomation Workup

Laboratory Studies

Imaging Studies

Other Tests

References

Tables

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